Notes on Ayurveda in Nepal and India

Observing an ayurveda session in New Delhi, India (Sept. 2012)

by Gideon Lasco, MD

LEH, JAMMU AND KASHMIR - The first step in anthropology is a step back. A dinner conversation becomes a form of ethnographic data-gathering when you cease participating in it solely, but also begin to observe. Sometimes, the problem in “stepping back” is being unable to step in again, and anthropologists are often observers of their own lives, more than those of others. On the other hand, whenever I am traveling, I find the anthropologist's perspective very useful. I am reminded of a friend of mine who is a hiker and a birdwatcher; she says that since the mountains are full of birds, she has no problems in joining my hiking trips; she can also do “incidental birdwatching”, as long as I don't mind her occasional stops.

Perhaps, traveling is much an enabler of anthropology as mountains are of birdwatching, only that I should also slow down a bit. Then, incidental anthropology can contribute as much to my understanding as a deliberate one.

This is how it has been in our field trip, where my classmates and I went to New Delhi to learn about Ayurveda. There were only three days scheduled for the actual “exposure” to Ayurveda, which consisted of meeting with private and public institutions of Ayurvedic medicine. However, I spent three weeks in India and Nepal, and my encounters with Indians of all walks of life broadened my perspective about Ayurveda.

The first South Asian city I visited was Kathmandu. I arranged for a meeting with the Fiipino community there, which mainly consisted of wives of Nepalese men. After exchanging pleasantries and receiving the plea for daing (dried fish) which they sorely miss, I had the chance to ask them about life in Hindi culture. They introduced some realities to me about Hindu culture, particularly the caste system. As daughters-in-law, their sorry role is to cook the food for the entire clan, because servants, being of a different caste, are forbidden to prepare or cook their masters' food. t is also very interesting how the women bring their own beliefs with them. In advising us to visit the Hindi temple called Pashupatinaph where cremations are routinely done, she warned us not to look at the priests, which had a powerful gaze that is sure to cause usog.

What do they do when a member of the family gets sick? Just like in the Philippines, Western medicine is at hand. When I asked about Ayurveda, one of them responded:

Yung Ayurveda, para 'yang kung sa atin, yung mga albularyo, pero sa kanila, big-time. May sarili silang ospital...pero meron din namang mga dyan lang sa tabi-tabi. Effective din daw pero kami, dun kami nagpapatingin sa doktor na parang sa atin lang... (Ayurveda, it's like what we have – the traditional healers – but to them, it's 'big time'. They have their own hospital, though there are also those that you can just find in the corner. They say it's effective but for us, we jus consult the regular doctor, just like in our [country])

Another adds:

Ayurveda kung tawagin, para yun sa mga sakit na hindi mapagaling ng mga doktor, yung mga malala na. Mas maganda daw ang pakiramdam. (What they call Ayerveda...it's for those who have illnesses that couldn't be treated by doctors, those which are already severe. They say that the feeling is good.) 

After our conversation, I tried to look at how the caste system has affected Ayurveda, but I was not able to get specifics. Many writers have written about the caste system as a “historical inequity” but apparently, in Ayurveda this was never a problem. Perhaps this is because this particular health system has co-evolved with Hindu society throughout the centuries.

In Kathmandu, there are several big hospitals, including a heart center, but you could also see Ayurvedic hospitals, clinics, and “chemists”, not to mention occasional advertisements for Tibetean medicine. It would become a foreshadowing of what I would see in India: medical pluralism.

***

ARRIVING IN New Delhi, I saw many more of the 'chemists'. Some sell exclusively  Western pharmaceuticals – at much cheaper prices (I bought two rounds of Azithromycin treatment, at P10/tablet). Other chemists sold both Western and Ayurvedic products, while still others focused primarily on Ayurveda.

After Taj Mahal and the inevitable gems and carpets that were peddled to us, we reached the highlight of our trip: visits to private and public institutions of Ayurveda.

On our first day, we went to a private Ayurvedic hospital – the Delhi branch of a chain of hospitals that from Kottakal, in Kerala. Our host was a scion of the Varier faimily, whose patriarch P. S. Varier established the first Ayurvedic hospital in 1902.

His office was just like any other MD in the Philippines: Framed diplomas, bookshelves full of medical textbooks, elegant interior design. He also wore a white coat, and  a stethoscope hung prominently on a rack beside his table. Perhaps the only thing that would not be found on a Filipino physician's office was a portrait of Dhavantari, the “god of Ayurveda”.

The way he talked was very physician-like: affable, congenial, and knowledgeable. He deftly answered the question of Dr. Gueco, a nephrologist, about side effects, invoking pharmacologic concepts of lethal dose and therapeutic index. Hand-in-hand with his knowledge of Western medicine was his eloquent exposition of Ayurveda, from its history, its eight specialties, and so on.

His manner and conduct; his personality, and his office – very Western, and yet, avowedly Ayurvedic, symbolizes and shows how Ayurvedic medicine try to achieve a “double legitimacy” of their heath care system but applying (or borrowing) scientific (i.e. biomedical) methods of validation. My classmates (and myself) were visibly impressed by this kind of proficiency and fluency in the language of medicine.


The next day, our meeting with the AYUSH Council (Ayurveda, Yoga & Naturopathy, Unani, Siddha, and Homeopathy Council) affirms what I observed in the private hospital: there is a conscious effort to present Ayurveda as professionalized and modern (i.e. Western). There is no mention of the Hindu religion, nor of the mantras that are required to make the therapy a success – a requisite act in traditional Ayurvedic practice. Instead, 14 successful randomized clinical trials on medicinal plants were presented, together with the curriculum for Ayurvedic medicine that is identical to that of Western medicine, including lessons in anatomy and physiology (side by side with “Ayurvedic literature”).

We see, thus, that the medical pluralism of India, elements that fortify the position of the dominant health system (i.e. biomedicine) are borrowed by the other health systems to strengthen their own validity and credibility. The less flattering (at least to the eyes of observers) aspects of Ayurveda, like the prayers, and the side effects of therapy using metals, were glossed over.

Moreover, there is an awareness that whatever Ayurveda is, it must fit within the larger picture of health care in India and elsewhere. Instead of being packaged as a health system that can take care of everything, its exponents highlight its strengths in focused areas, such as chronic illnesses, specifically psoriasis and rheumatism, as well as preventive care, and palliative care. The AYUSH people are very careful not to make claims of Ayurveda as superior to other healing systems. It is as if there is an unspoken armistice of Western medicine, that it will be tolerated as long as long it does not encroach on Western medicine itself:

Patients are free to choose what treatment they want. If they choose Ayurveda, okay. If they choose Western medicine, it's okay also. We do not impose Ayurved. It's up to them. And if we think that Western medicine is better, for instance for emergencies, we also tell them.

Another often-highlighted aspect of Ayurveda is  its “safety” i.e. “no side effects” and “it is all natural” is an attribute of Ayurveda that is oft-mentioned, by laypersons and professionals alike.

In Ladakh, in the Indian province of Jammu and Kashmir, I met several Indians,  from various cities, and I had the chance to  ask them what they think about Ayurveda. An Indian couple, from Mumbai, spoke highly of it. Another couple, from Assam, had a son who was a medical student, and said that they preferred Western medicine, citing its proven safety. But even they acknowledge that Ayurveda has its strengths, like “those hopeless cases”. Moreover, they have personal experiences of illnesses. As an affluent man from Delhi told me:

For our chidren's coughs and colds, sometimes we use Ayurvedic medicines, sometimes, we buy from the chemist. The irony is, I suspect that even we don't give them anything, they'll still get well! 

What emerges from our India experience is the existence of parallel, but co-adaptive professional sectors of medicine, folk and popular sectors that employ elements of both, and patients taking their pick from various “choices”, using their own experiences as guide. “Doctor shopping” becomes more interesting in a world where various developed and respectable health care systems exist; it becomes “health care system shopping” instead.

Observing the reactions of my classmates, and reflecting on my own, two things impressed us: one, the exotic-ness, and its Western-ness of it. Perhaps, in the future of Indian health care, Ayurveda will be indistinguishable from Western medicine, Ayurveda being so Westernized, and Western medicine adopting some of the best practices of Ayurveda.

As for religion, Western medicine was once closely linked with Christianity, but it has since distanced itself from it. I would venture to speculate that as Ayurveda becomes more “scientific”, and as it draws more legitimacy from clinical studies and experimental methods, it, too, will do away with its “excess baggage of Hinduism” whenever convenient; even as Hinduist Ayurveda will continue to appeal to its traditional Indian clientele.

Based on what I have seen and learned in India, then, the success of Ayurveda can be explained in terms of the following characteristics of it, all of which contribute to the claims of legitimacy and validity of Ayurveda:

1. Longevity – The fact that Ayurveda has been around for so long is used to support its claim as a legitimate health care system. It is true that Ayurveda has its origins from the first millennium before Christ, and has been in continuous use since then. However, the idea of an unchanging, timeless system of medicine needs to be challenged. Islamic influence in India, which brought the unani system of medicine, has also influenced Ayurveda, beginning in the 1100s and reaching its zenith during the Mughal empire (1556-1758). Moreover, following the introduction of Western medicine in the 19th century, Ayurveda has gone through a series of adaptations that continue to the present, absorbing the best of Western medicine and developing its own strengths.

2. Claims to divinity – Closely related to longevity is claims to divinity that Ayurveda espouses. Dhavantari, the mythical founder of Ayurveda, is also known as the physician to the gods. The images of Dhavantari in clinics and wards show that this mystical connection is still honored; a large statue of the god adorns the lobby of AYUSH compound in New Delhi. I had the impression that this is something that was not highlighted to us by the people we met, probably since we were outsiders to Hindu culture. But its presence is evident in many places and instances. The revered founder of the Arya Vaidya Sala private institution, in his official biography, is acclaimed not only for his pioneering work in Ayurveda, but there is a short paragraph at the end telling of his commitment to a Hindu dance troupe.

The complexity of India makes it difficult to predict whether the relationship of Ayurveda with Hinduism will continue to be embraced by its exponents in the future. With Ayurveda increasingly validated by science, perhaps there would a wider latitude for it to become more “secularized”. 

On the other hand, by over-embracing the biomedical divorce of science and religion, Ayurveda might undermine the very reason for its appeal in the first place: its holistic approach to health, seeing its spiritual and emotional dimension alongside the physical. Given this, I would wager that Dhavantari's statue in the AYUSH building will still be there when the next batches of medical anthropology students go on their Indian field trip

3. Efficacy – Efficacy is crucial to any medical system, and this can be measured either as perceived by the people, or by an external mechanism for validation, such as the scientific method. Importantly, the latter method feeds into people's perceptions as well, making it very influential, especially in cultures where “blind faith in science” - as Hawking's philosophical perambulations have been described - is prevalent. In my interviews with people, most of them say that Ayurveda works for them, and they cited their personal experiences.

The scientific case for the efficacy of Ayurveda is more complicated, and perhaps this is a project that will take decades to resolve. A PubMed search would reveal mixed results of conclusive and inconclusive studies, although there is a growing consensus that Ayurveda has benefit in particular illnesses, such as rheumatoid arthritis, chronic illnesses, and palliative care. Moreover, herbs and therapies such as yoga and meditation that have long been part of Ayurvedic therapeutics are increasingly validated by Western studies.

The open-ness of Ayurvedic institutions to having its therapies examined under the microscope of biomedicine will ultimately be for its good, allowing it to have both the “double legitimacy” of sacred texts and scientific research, and the reflexivity that will allow self-improvement.

4. Safety –  Doctors and patients of Ayurveda agree that one of the remarkable strengths of Ayurveda is the fact that it has “no side effects”. This reasoning comes from the fact that since Ayurveda draws its remedies mainly from plants and natural products, there is none of the “harmful chemicals” that go with Western pharmaceuticals. This discourse is not unique to India; we see this being played across various cultures where Western medicine and traditional systems of healing are compared and contrasted. In the Philippines, we see this in the “cough remedy wars” being waged between manufacturers of lagundi and manufacturers of conventional cough syrups.

Many critics of Ayurveda have pointed out that its use of heavy metals as therapy is problematic, and the toxicity as a result of such therapies is becoming a  growing albeit poorly-documented problem that is spreading globally as Ayurveda becomes global. As a 2008 report concludes:

A significant proportion of Ayurvedic medicines contain heavy metals and there are numerous reports of heavy metal, in particular lead, poisoning related to use of these products. In patients, both adults and children, presenting with unexplained anaemia, or unexplained gastrointestinal or neurological symptoms, heavy metal poisoning should be considered in the differential diagnosis.  

The doctors we interviewed counter that these side effects are no different from side effects from biomedicine: they are inevitable in the wider scale, but avoidable if proper techniques are followed.

This issue is hard to adjudicate, given the limited number of studies that deal with toxicity from Ayurvedic therapies, and the qualification of what constitutes “good Ayurvedic practice”. What is important to note, however, is the fact that Ayurveda's perceived safety contributes to its popularity.

5. Holism – The approach of Ayurveda to health is no support the body, strengthen the immune system; not to kill the germs. The massages are said to be “very relaxing” and “very comforting”. Perhaps, the function of Ayurveda as a provider of comfort is no different from the hilot sa panganganak, who provides much comfort (ginhawa) to the women after childbirth, something that Western medicine does not have.

6. Adaptability – This is not an external feature of Ayurveda, but as we mentioned earlier, it is a striking asset without which, in all likelihood, Ayurveda would not have survived. Perhaps, this feature is the one that enabled it to achieve longevity and receive validity from both the scientific and the sacred.

In my interviews with traditional healers in the Philippines, I was also able to observe much adaptation, with some healers using cellphones, X-rays, and other technologies; while others take on emergent diseases using their own techniques, and in this way, cancer, dengue fever, and HIV/AIDS falls under the scope of their practice. What is remarkable in India, however, that  this adaptation is done in an organized, not individual scale.

The degree program for Ayurvedic medicine, however, is styled “Bachelor of Ayurveda, Medicine, and Surgery”. Established in 1940, its holders are entitled to practice not just Ayurveda, but also modern medicine. This indicates that early on, the degree of integration has been fairly high in India, which can explain why Ayurveda has attained a degree of sophistication that cannot be said of other traditional medical systems around the world, with the exception of Chinese and Korean medicine, as well as, to a certain extent, homeopathy.

***

In this short piece, I related my experiences and insights on Ayurveda in India. But what of yoga, siddha, unani, and homeopathy? We did not have time to explore these other systems of healing, but surely, they add to the richness and diversity of health care in India. Scratching the surface of it, I am no different from Alexander the Great, who was, as an important part of the Ayurvedic history narrative goes, “very much impressed”.

India
September 2012

We ourselves should be tourism ambassadors

by Gideon Lasco

NEW YORK CITY - On a recent trip to Ecuador I managed to convince two backpackers to visit the Philippines. One of them, a medical doctor from the Netherlands, was planning to do a backpacking trip around Southeast Asia but hadn't considered the Philippines at all until I showed her pictures of Coron and Puerto Princesa. The other, a fresh graduate from Germany, had already heard nice things about the Philippines and just needed some convincing. A mountaineer, he was pleasantly surprised that there are lots of hiking possibilities in the country - from volcanoes like Mt. Apo in Southern Mindanao and Kanlaon in Negros to long walks in the Cordilleras that live up to the Department of Tourism’s one-time tagline of “nature, adventure, and culture”.

My interactions with foreigners have made me realize how important personal endorsements can be in the decisions of travelers on which countries to visit. Testimonials can be just as powerful as the best pictures in travel magazines, or the most crisp videos on travel shows, in enticing people to visit. Thus, Filipinos who work and travel abroad - of whom there are millions - are an untapped resource in the government's efforts to boost tourism in the country, especially in light of its target of 10 million visitor arrivals in 2016.

***

It must begin with our being proud about our country. If we ourselves don’t think our country is worth visiting, how can we convince others to come? Of course, we do have our own little complaints about the Philippines - the traffic, the policitians, the slow Internet connection, and an even slower bureaucracy. But then, which nation doesn’t have problems? These misgivings aside, we have to put our best foot forward and show that there is much more to the Philippines than the problems we sometimes tend to highlight.

Next, we must make a convincing case for why visitors should come to the Philippines. That the cost of living is generally cheap, and that most Filipinos speak English, are good enticements. But we must know the best of what our country has to offer, and it will also help if we know what our would-be guests are interested in. Divers have plenty of choices as within the Philippines lies the “center of the center" of world’s marine biodiversity. Those seeking a more cultural experience should discover our heritage towns, like Intramuros, Vigan, Miag-ao, to name a few - or charming locales like Batanes and the many mountain towns in the Cordilleras. Shoppers will enjoy the malls of Manila and Cebu, while nature lovers may be better off heading straight to Palawan or Bukidnon. There are great caves in Samar for spelunking, limestone cliffs in Cebu for rock climbing, great seafood everywhere…even one day out of Manila is enough to take visitors to the lush tropical forests of Mt. Makiling or stunning views of volcanoes Taal and Pinatubo.

Of course, we must be honest about what visitors should expect. Typhoons, for instance, can thrwart planned trips, especially in the wet season. Traffic in Manila can be frustrating. Then there are places that might be risky for foreigners to visit. However, we must emphasize how circumscribed these places are. Moreover, while these considerations may deter a few, most travelers are aware that there’s always a risk anywhere and that it’s part of the adventure of traveling.

Finally, offering continued assitance will go a long way. I told my newfound friends in Ecuador to feel free to email me if they have questions. Having a contact in an unfamilar place can be the final push people need to come and visit. And the information they need is often effortless for us to provide. Surely it will be easy for us to give tips about taxi drivers in Manila, or how to get to Baguio by bus. By accommodating their inquiries, we are already enacting the hospitality that Filipinos are known for.

***

Tourism is not without its criques, and certainly there are many issues that we need to address before we can wholeheartedly embrace it. Though the tourism sector is said to have contributed 6-7% of the country’s GDP in the past years, we must ask whether the profits in tourism have translated to better quality of life among communities within tourist destinations. We must also ask whether tourism has been environmentally sustainable, as in places like Sagada and Boracay that are clearly going beyond their “carrying capacities” during peak seasons.

These concerns notwithstanding, I think we are all agreed that tourism, done responsibly and sustainably, has a great potential in contributing to our country’s growth. More than the economics, tourism promotes understanding among cultures, and this goodwill can doubtless help many overseas Filipinos, as well as our diplomatic standing in general. Finally, we can actually steer tourism in a more favorable way by directing our guests to experiences and establishments that are friendly to local communities and the environment.

In ending, let me attest my conviction that the Philippines is one of the best places in the planet and it has much to offer to visitors from all walks of life. But we cannot solely rely on occasional TV commercials, ”It’s more Fun in the Philippines" billboards, and occasional inclusions in “must-visit” lists by travel magazines to make this known to people around world, especially if we have a more direct way to get them to come. Indeed, if our tourism sector is to grow, we must take it upon ourselves to be ambassadors and endorsers of our own country.

Mt. Cloud Bookshop in Baguio City: A treasure-trove of Philippine culture and scholarship

BAGUIO CITY - One of my favorite stops here in the City of Pines is the historic Casa Vallejo in Upper Session Road. Dating to 1909, a year before the establishment of Baguio City itself, it is among the oldest surviving structures in the city, surviving both World War II and the Baguio earthquake of 1990. Just as it has been at some points in its storied life, it is now a boutique hotel, and the venue of other interesting establishments. Aside from the fantastic Hill Station Restaurant, the North Haven Spa, and even a art-flim cinema, it is home to Mt. Cloud Bookshop

“We don’t just sell books, we love them!” one of the posters read. And I must add that the bookshop owners must have a special affection for books of and about Filipinos and the Philippines.

Scholars and aficionados of Philippine history and culture will be delighted to see several works of William Henry Scott, alongside Ileto's Pasyon and Rebolusyon. Those of us who wish to have a deeper understanding of our contemporary socio-economic situation will appreciate the works about labor unions, a chronicle of the Communist Party of the Philippines, and number of reflections about the ramifications of globalization and neoliberal capitalism in the Philippines.

As an anthropologist, I was thrilled to see various ethnographic works, and I got myself two of theme: Kale Fajardo's Filipino Crosscurrents: Oceanographies of Seafaring, Masculinities, and Globalisation and Bruno Bottignolo's Celebrations with the Sun: An Overview of Religious Phenomenon among the Badjaos. There were also narratives of displacement among the Aetas in the wake of Mt. Pinatubo's eruption, among many others. Also interesting were local histories, such as Nita Berthelsen's The Tayabas Chronicles, Reynaldo Ileto's Maguindanao 1860-1888, and Warren's The Sulu Zone 1768-1898. What I planned to be a quick stop turned to be an hour-long bibliographic adventure!

The literature section, on the second floor, is equally impressive, and is arranged according to genre: novels, short stories, poems, plays, nonfiction, among others. Even Filipino comics are on display. For any lover of Philippine culture it is truly a joy to see all those books - from Jose Garcia Villa's poems to the short stories of Butch Dalisay and even Romi Garduce's account of his Seven Summits adventures.

Finally, there are coffee table books about Baguio City, among Filipino art, architecture, weaving, pottery, and many others. Wherever your interests lie, there is surely a gem waiting to be found! Most of the books are priced around 500 pesos, but there are good bargains too, with some short story collections at 100 or even 50 pesos apiece.

Aside from the extensive collection are books about our neighbors in Southeast Asia. There's a book called "The Rice Birds: Folktales from Thailand" and in the same shelf there's "Fishing, Hunting, and Headhunting in the Former Culture of the Ngaju Dayak in Central Kalimantan"! These books are rare, and are unfortunately "exotic" in the reality of our cultural disconnect with our geographic neighbours. So it is another epiphany to see them in that bookshop in Baguio.

***

To a certain extent, bookstores are revelatory of culture, and one only needs to go to National Bookstore or Fully Booked to see how “Westernized” our sensibilities are, with Stephenie Meyer, E. L. James, and Paulo Coelho gracing the entrance while our great writers, such as Nick Joaquin and F. Sionil Jose, are relegated to the peripheries.

Which is why Mt. Cloud Bookshop is refreshing change. Far from marginal, books about the Philippines and by Filipino authors take (their rightful) centre stage. Like a passing cloud that invites introspection, these books make us look within, and can teach us many things about our beautiful culture, our beautiful land.

Baguio City
January 20, 2015

Books about the Philippines take centre stage in Mt. Cloud bookshop in Baguio

Notes on the folk medicine of the Rizalistas in Dapitan

A replica of Rizal's house in Dapitan, where he was exiled for four years
(G. Lasco, 2010)

By Gideon Lasco, MD

DAPITAN – The Rizalistas here converge around Rizal Park in Brgy. Talisay, where Jose Rizal stayed in exile for four years (1892-1896). They have homes built within the vicinity of the park, and they have an alleged membership of a few thousands. Most of them come from Dapitan, Dipolog, and the surrounding towns of Zamboanga del Norte.

On August 28, 2010, I conducted an discussion among three women and one man, aged 60, 32, 55, and 67 respectively. I also interviewed their most experienced manghhilot, who introduced himself as Isidro, while he performed the hilot (therapeutic massage) on me for one hour. Furthermore, I conducted interviews with other Rizalistas as well as residents of Dapitan from August 27-29. The information I derived from these discussions are by no means exhaustive nor comprehensive; they are merely offered as a glimpse of the Dapitan Rizalistas’ philosophy and practice of folk medicine.

Their philosophy of healing may best be gleaned from how the view Rizal the healer. Significantly, our informants ascribe Rizal’s healing prowess not only to his medical education in Europe, but also to his inherent spiritual power. They also say that Rizal practiced hilot (therapeutic massage) in Dapitan, and that he employed herbal medicines. When asked if they know of any account, by either written document or oral tradition, about the particular herbs Rizal used, if any, they were not able to give an answer. However, in the correspondence between Rizal and Blumentritt while the former was in exile, the claim of Rizal’s use of herbs seems to be corroborated.

Our informants acknowledge that much of their medical tradition was taught by their founder, which they call Mahal na Haring Filemon, who is still living at age 79. Interestingly, however, they claim that their source of knowledge is ultimately Rizal still, and it is through revelation that this knowledge was conveyed to them via their founder.

The practice of folk medicine among the Rizalistas is limited to two components, namely pharmacotherapy (gamot) and therapeutic massage (hilot). Arguably, there is a third, inherent, spiritual component; this is expected for the Rizalistas are first and foremost a spiritual group which recognizes the deity of Rizal in varying degrees.

The pathophysiologic basis of disease is derived from prevalent folk theories of illness causation, though syncretism is observed: terms such as high cholesterol and uric acid have entered their body of medical knowledge, creating an interesting amalgam of beliefs. The acquisition of Western terms has given rise to simplistic explanatory models for particular illnesses. For instance, hypertension is seen simply as a state of high cholesterol; whereas various arthritides are attributed to elevated uric acid. Elemental forces, such as lamig and hangin, are seen as etiologies of both primary diseases and complications. Despite the use of these terms, however, there does not seem to be a coherent, systematic theory of pathophysiology.

There are only two drugs used as therapy: one is a dark red, concentrated syrup called dugoang serap; the other is called ‘fire capsule’ and is said to be derived from the plant called ‘luyang kahoy’. Both have a wide range of alleged therapeutic indications.

Dugoang serap (perhaps serap is a corrupted form of ‘syrup) is derived from the bark of a tree called dugoang kahoy. I was instantly reminded of a folk therapy I was given on the deep jungle of Mt. Mantalingajan by a Tau't Bato panglima: when I complained of weakness (we had been climbing for 4 days, 11 hours a day), they got a bark, which, when dipped into water, turned the water red. They call it 'dugong halaman'.

Dugoang serap is said to be curative for leukemia, hepatitis, dengue fever, mga sakit sa dugo, binat, and many other diseases and disease categories. A teaspoon of the syrup is mixed with hot water and the concoction is drank like coffee, once or twice daily. A 375mL bottle costs 1000.

The potency of dugoang serap draws from the belief that blood is life; therefore, intake of a blood-like substance is life-sustaining. This will also figure in the discussion of hilot, or massage.

The other pharmacotherapeutic agent is the fire capsule, which is allegedly derived from the bark of a plant called luyang kahoy. This tablet is particularly useful for kidney and gastrointestinal problems, but is also effective for cancer, ulcer, heart disease; it is essentially promoted as a panacea. The dose is once daily, but if one wants quick results, a single dose of 5 capsules can be ingested. Moreover, dose is faith-dependent; a person with much faith can get by with just the minimum of dosages. Each capsule is sold for 20 pesos.

Finally, hilot itself is employed as therapy; a “ten-step technique” is taught by the group’s founder. The massage is officially called “Philippine New Life Therapeutic Massage” and is said to be both a “spiritual” and “material” massage. The “spiritual” component is allegedly the inherent healing power within the healer, that can be boosted by faith and spiritual acts such as prayer and penitence.

The explanatory model for the ‘mechanism of action’ of the hilot is interesting. According to Isidro, the blood vessels are the primary target of the massage. The kneading action stimulates the blood vessels, strengthening them:

Kapag hinihilot, yung mga ugat ang hinahanap…Ang dugo ay nagiging bago, nalilinis. (When you do the 'hilot', you're searching for the blood vessels. The blood is renewed, cleansed)

The cleansing effect on the blood is then connected to the lowering of cholesterol, saying that the stimulation of the blood vessels cause the dislodgment of cholesterol plaques. Washing of laundry is used as metaphor:

Parang labada na may mantsa, kapag nakusot, nawawala, nalilinis…Ganun ang nagagawa ng hilot kaya kailangan may training para alam kung ano dapat ang hilutin. (Just like laundry that has stains, if you scrub it, the stains get removed; they are cleaned. That's what hilot does that's why you need the training so you know what to massage)

When asked however how the ‘blood vessel’ theory of massage can explain pain relief, Isidro answers that a secondary target of the massage are the nerves, the realignment of which can relieve pain. Interestingly, there is little distinction between blood vessels and nerves in the Tagalog and Bisaya languages; for many speakers ugat can pertain to both. Isidro, while performing the hilot, was able to correctly identify and locate many blood vessels and trace their course in the human body. Gentle massage of the femoral vessels, he said, while massaging the femoral area, can strengthen a man. Impotence, he added, can be alleviated by massaging the hypogastric and inguinal areas, with improved circulation in mind.

Hilot, like pharmacotherapy, has many indications; but it is seen as the weaker form of therapy, used for mild cases and for general well-being, except in some instances where it is seen to be a superior therapy (e.g. in the case of impotence). The hilot has to be performed in a sequential manner, or else the efficacy would be greatly diminished, if not nullified. The need for a proper sequence draws from the spiritual aspect of the hilot.

The Rizalistas in Dapitan are an interesting focus of study because they exemplify many of the Filipino folk beliefs and values regarding medicine. The spiritual component of healing figures prominently; and the folk theories of disease causation are still used, albeit with substantial borrowing of concepts from Western medicine. I believe that a more in-depth study of their beliefs and practices, and perhaps a comparison among various Rizalista groups according to geography, would be a good direction for research.

Dapitan
August 29, 2010